The funding of Estonia’s health care system is based on health insurance that follows a solidarity principle. The aim of the health insurance is to cover the health care costs of insured persons for the prevention and treatment of illnesses, funding the purchase of medicines and medical aids and to pay monetary compensations. Estonia’s health insurance is based on instalments, i.e. is in a large part dependent on the number of working age people making monetary contributions and their level of income. Therefore, the ageing of the population can adversely affect the financial sustainability of the health insurance, i.e. the long-term balance between funding options and costs of the system.
However, the change in population structure isn’t the only factor influencing sustainability and its effect shouldn’t be overestimated, because non-demographic factors, such as a rise in health service prices and health care workers’ salaries and the implementation of new technologies can influence the sustainability even more than factors that depend on demographic changes. There are also various factors that shouldn’t be underestimated, such as: how the health care system is organised and managed, what is the division of labour within the system, what technologies are used, the network of service providers and how the services are provided.
In Estonia, the financial sustainability of health insurance has been assessed in various studies and analyses (Võrk et al. 2005; Thompson et al. 2011; Praxis 2011) and, on the basis of the selected assumptions, it has been concluded that the health care system isn’t financially sustainable in the long term on the current basis. The sustainability of Estonia’s health insurance depends on the demographic developments as well as the organisational factors of the system. The health insurance sustainability assessments of the Health Insurance Fund, WHO and Ministry of Social Affairs (Thompson et al. 2011) and Praxis (Praxis 2011) have demonstrated a major influence of the health care service prices and the wage cost component on sustainability.
For this project a model for predicting health insurance revenue and costs was created that would be able to assess long-term financial sustainability as well as test the effect of various scenarios on sustainability. It is a management tool for health care organisers, who can make an informed assessment about the effects various measures and trends have on the long-term balance of health insurance revenue and costs. The model allows the assessment of the effect of various components (labour, prices, service providing structure, external risks, taxes) on financial sustainability. This report presents the background of prognostic models and prognostic methodology, also the output and possible uses of the prognostic model.
The research report consists of five chapters. After the introductory chapter about the necessity of the prognostic model, an overview of the theoretical background of health insurance prognosis is presented. Then follows a chapter introducing the methodology of the prognostic model, after which the prognostic results together with exemplary sensitivity analysis are presented. Finally the summary of the study is presented.
The report is in Estonian, but translation is possible. Please contact the authors.